Authors: Najah Adreak, MD, MSc in Surgery, University of British Columbia | Editors: Romina Garcia de leon and Shayda Swann
Published: February 16th, 2024
Have you heard that heart disease is a man's disease? In fact, heart disease is the leading cause of death for women worldwide. Since 2015, Canada and other nations have reported an increase in female deaths from heart disease, highlighting the urgent need for comprehensive understanding and targeted interventions. In Canada, every 20 minutes, one woman dies from a heart attack, every 7 minutes one woman is diagnosed with heart disease, and women are 7x more likely to die of cardiovascular disease than breast cancer. Heart and vascular disease stand as the leading causes of hospitalization and premature death among women in Canada, affecting one in three women globally. Despite these alarming figures, women remain understudied, underdiagnosed, and under-treated, with healthcare providers often unaware of their unique risk factors and atypical presentation of heart and vascular disease.
How Heart Disease Differs in Women: Unveiling the Discrepancies
The distinct nature of heart disease in women compared to men emphasizes the need for specialized attention. Factors such as different symptoms, risk factors, and causes necessitate unique diagnostic and treatment approaches.
Heart attacks in women often go unrecognized. The Hollywood-style chest pain:” Chest-clutching, crushing pain’’ may not be the predominant symptom, with women more likely to present with 3+ symptoms, including jaw, neck, arm, or back pain, excessive sweating, shortness of breath, stomach discomfort, and more. Downplaying symptoms and attributing them to non-heart-related issues can lead to misdiagnosis or underdiagnosis. Proactively seeking medical help is important to ensure proper diagnosis and treatment.
Did you know that the early signs of heart attack are missed in 78% of women, especially if they are young or come with less common symptoms? Women and their doctors can be slow to identify the signs and symptoms of a heart event. According to a study published in The New England Journal of Medicine in 2000, women are 7 times more likely to be sent back home from the ER while having a heart attack, when compared to men.
It is imperative to also acknowledge the often overlooked burden placed on women due to caregiver responsibilities and the strain arising from juggling work and household duties. Women — particularly younger women — may have their signs attributed to anxiety, heartburn, or other “female” issues and are less likely to get immediate treatment.
Causes of Heart Disease in Women: Beyond the Basics
Heart disease can manifest differently in women and men, presenting with various types.
Women, in particular, are more susceptible to distinct conditions, such as a tear in the large blood vessels of the heart (spontaneous coronary artery dissection, SCAD), tightening of the large heart blood vessels that restrict blood flow (coronary vasospasm), small vessel disease (microvascular dysfunction), weakened heart due to a stressful event (Takotsubo cardiomyopathy), and weakened heart during or after pregnancy (peripartum cardiomyopathy). The prevalence of SCAD, for instance, is notably higher in women, making up to 35% of heart attacks in women under 50. Notably, smoking, diabetes, high blood pressure, and a family history of heart disease serve as notable warning signs specifically for women. For instance, women living with diabetes are 3x more likely to die from heart disease compared to men.
Several unique risk factors contribute to an elevated risk of heart disease in women, including specific pregnancy complications such as premature birth, diabetes or hypertension during pregnancy, and preeclampsia. Additionally, early menopause, polycystic ovary syndrome, and systemic inflammatory and autoimmune disorders like rheumatoid arthritis and lupus can increase the risk. Indigenous women in Canada and those from particular racial and ethnic groups such as South Asian, Chinese, black and Afro-Caribbean descent experience higher rates of heart disease and poorer outcomes compared to Caucasian Canadians. They are also at a higher risk of cardiovascular disease.
Empowering Women: Mitigating Heart Disease Risks
Despite the concerning statistics, more than 80% of risk factors for heart and vascular diseases can be prevented through proactive measures:
- Be Active and Keep Moving: Regular physical activity is crucial for maintaining heart health. Check this guideline for more
- Eat a Variety of Nutritious Foods
- Manage Stress
- Live Free from Commercial Tobacco and Vaping
- Limit Alcohol and Substance Misuse
- Get Regular Health Checkups
Wear Red Canada: A Collective Effort for Women's Heart Health
In 2018, the Canadian Women’s Heart Health Alliance was established to transform clinical practice and enhance collaborative action on women’s cardiovascular health in Canada. The annual Wear Red Canada awareness campaign, set on February 13, aims to improve heart health for women of all ages.
Participation in Wear Red Canada is open to all, with activities ranging from wearing red to sharing key messages on social media using hashtags #HerHeartMatters and #WearRedCanada. Participating in virtual movement challenge events, attending webinars, and engaging with the Wear Red Canada community on Facebook are impactful ways to support women's heart health.
Understanding the nuances of heart disease in women is essential for effective prevention and treatment strategies. By acknowledging the differences and taking proactive steps, we can work together to reduce the prevalence of heart and vascular diseases in women.